VT
Vermont Senate Bill S0064

Vermont 2025-2026 Regular Session

Vermont Senate Bill S0064 Compare Versions

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11 BILL AS INTRODUCED S.64
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55 VT LEG #380323 v.1
66 S.64 1
77 Introduced by Senators White, Baruth, Beck, Brennan, Brock, Chittenden, 2
88 Clarkson, Collamore, Douglass, Hardy, Harrison, Hart, Major, 3
99 Mattos, Norris, Plunkett, Vyhovsky, Weeks and Williams 4
1010 Referred to Committee on 5
1111 Date: 6
1212 Subject: Professions and occupations; Office of Professional Regulation; 7
1313 health care professionals; optometrists 8
1414 Statement of purpose of bill as introduced: This bill proposes to revise and 9
1515 further define the scope of practice for optometrists. It would also create an 10
1616 advanced therapeutic procedures specialty that would allow qualified 11
1717 optometrists to perform certain advanced therapeutic procedures. 12
1818 An act relating to amendments to the scope of practice for optometrists 13
1919 It is hereby enacted by the General Assembly of the State of Vermont: 14
2020 Sec. 1. 26 V.S.A. § 1703 is amended to read: 15
2121 § 1703. DEFINITIONS 16
2222 As used in this chapter: 17
2323 (1) “Board” means the State Board of Optometry. 18
2424 (2)(A) The “practice of optometry” means any one or combination of 19
2525 the following practices: 20 BILL AS INTRODUCED S.64
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3030 (A)(i) Examining the human eyes and visual system for purposes of: 1
3131 (i)(I) diagnosing refractive and functional ability; or 2
3232 (ii)(II) diagnosing the presence of eye and adnexa disease or 3
3333 injury, treating the disease or injury with the appropriate therapeutic 4
3434 pharmaceutical agents and procedures in accordance with this chapter, and 5
3535 making referrals to the appropriate health care provider when warranted. 6
3636 (B)(ii) Diagnosing and correcting anomalies of the refractive and 7
3737 functional ability of the visual system and the enhancement of visual 8
3838 performance including the following: 9
3939 (i)(I) prescribing and using ophthalmic lenses, prisms, 10
4040 autorefractor or other automatic testing devices, frames, ophthalmic aids, and 11
4141 prosthetic materials as consistent with the health of the eye; 12
4242 (ii)(II) prescribing and employing contact lenses; and 13
4343 (iii)(III) administering visual training, vision therapy, orthoptics, 14
4444 and pleoptics. 15
4545 (C)(iii) Prescribing and administering appropriate therapeutic 16
4646 pharmaceutical agents, as defined in this section, for the diagnosis, 17
4747 management, and treatment of the eye and adnexa. 18
4848 (D)(iv) Removing superficial foreign bodies from the eye and 19
4949 adnexa; epilating the eyelashes, including by electrolysis; and punctal dilation, 20
5050 lacrimal irrigation, and punctal plugs insertion. 21 BILL AS INTRODUCED S.64
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5555 (E)(v) Managing the following types of glaucoma in patients who are 1
5656 16 years of age or older: 2
5757 (i)(I) adult primary open angle glaucoma; 3
5858 (ii)(II) exfoliative glaucoma; 4
5959 (iii)(III) pigmentary glaucoma; 5
6060 (iv)(IV) low tension glaucoma; 6
6161 (v)(V) inflammatory (uveitic) glaucoma; and 7
6262 (vi)(VI) emergency treatment of angle closure glaucoma. 8
6363 (vi) For an optometrist holding an advanced therapeutic 9
6464 procedures specialty issued pursuant to subchapter 5 of this chapter, 10
6565 performing the following advanced therapeutic procedures: 11
6666 (I) surgery to remove lesions from the eye and adnexa and the 12
6767 accompanied restoration of tissue, including only the following: 13
6868 (aa) excision and repair of nonrecurrent chalazia; 14
6969 (bb) excision and biopsy of nonrecurrent lesions of the 15
7070 adnexa without characteristics or obvious signs of malignancy, excluding any 16
7171 lesion involving the eyelid margin, involving the lacrimal supply or drainage 17
7272 systems, deeper than the orbicularis muscle, or larger than five millimeters in 18
7373 diameter; 19
7474 (cc) closure of wounds resulting from removal of a lesion; 20 BILL AS INTRODUCED S.64
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7979 (dd) repair of an eyelid laceration not larger than 2.5 1
8080 centimeters, not deeper than the orbicularis muscle and not involving the 2
8181 eyelid margin or lacrimal drainage structures; and 3
8282 (ee) corneal crosslinking; 4
8383 (II) the following laser procedures: 5
8484 (aa) laser capsulotomy; 6
8585 (bb) laser peripheral iridotomy; and 7
8686 (cc) laser trabeculoplasty; and 8
8787 (III) the following injections: 9
8888 (aa) injections of therapeutic pharmaceutical agents into the 10
8989 eyelid or its adnexa, including into the subconjunctival space, and including 11
9090 injections for the removal of chalazia and injections to administer local 12
9191 anesthesia; 13
9292 (bb) injections to perform fluorescein angiography; 14
9393 (cc) injections of epinephrine for treatment of anaphylactic 15
9494 shock; and 16
9595 (dd) if authorized by the Commissioner of Health during a 17
9696 public health emergency, vaccinations for systemic health reasons. 18
9797 (B) The practice of optometry does not include performing any of the 19
9898 practices set forth in section 1720 of this chapter. 20
9999 * * * 21 BILL AS INTRODUCED S.64
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104104 (6) “Adverse event” means any untoward incident, therapeutic 1
105105 misadventure, iatrogenic injury, or other undesirable outcome directly 2
106106 associated with care or services provided by a health care provider or a health 3
107107 care facility, as those terms are defined in 18 V.S.A. § 9402. 4
108108 (7)(A) “Therapeutic pharmaceutical agent” means any prescription or 5
109109 nonprescription drug used or prescribed for the diagnosis, prevention, 6
110110 treatment, or mitigation of abnormal conditions and pathology of the human 7
111111 eye or its adnexa. 8
112112 (B) “Therapeutic pharmaceutical agent” does not include: 9
113113 (i) any drug or other substance that must be administered by 10
114114 intraocular injection or intraocular implementation, except as authorized by 11
115115 subdivision (2)(A)(vi)(III) of this section for an optometrist holding an 12
116116 advanced therapeutic procedures specialty issued pursuant to subchapter 5 of 13
117117 this chapter; or 14
118118 (ii) any drug or other substance that is prohibited under subsection 15
119119 1720(b) of this chapter. 16
120120 Sec. 2. 26 V.S.A. § 1716a is amended to read: 17
121121 § 1716a. RENEWAL 18
122122 (a) Licenses shall be renewed every two years upon payment of the 19
123123 required fee, provided that the person applying for renewal completes at least 20
124124 40 hours of continuing education, approved by the Board, during the preceding 21 BILL AS INTRODUCED S.64
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129129 two-year period and holds a current cardiopulmonary resuscitation 1
130130 certification. 2
131131 (b) Licensees holding an advanced therapeutic procedures specialty 3
132132 pursuant to subchapter 5 of this chapter shall, during each two-year licensure 4
133133 period, complete an additional five hours of continuing education, approved by 5
134134 the Board, in the advanced procedures. 6
135135 Sec. 3. 26 V.S.A. § 1720 is added to read: 7
136136 § 1720. PROHIBITED PRACTICES 8
137137 (a) An optometrist shall not perform any ophthalmic surgeries, with or 9
138138 without the use of lasers, or injection procedures, other than those set forth in 10
139139 subdivision 1703(2)(A)(vi) of this chapter. This prohibition includes the 11
140140 following procedures, which an optometrist is prohibited from performing: 12
141141 (1) retinal laser procedures, laser-assisted in situ keratomileusis 13
142142 (LASIK), photorefractive keratectomy, laser epithelial keratomileusis, or any 14
143143 forms of refractive surgery; 15
144144 (2) penetrating keratoplasty, corneal transplant, or lamellar keratoplasty; 16
145145 (3) the administration of general anesthesia; 17
146146 (4) surgery done with general anesthesia; 18
147147 (5) laser or nonlaser injection in the posterior or vitreous chamber of the 19
148148 eye to treat any macular or retinal disease; 20 BILL AS INTRODUCED S.64
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153153 (6) surgery related to removal of the eye or adnexa, including the 1
154154 eyeball, from a living human being; 2
155155 (7) surgery requiring full-thickness incision or excision of the cornea or 3
156156 sclera other than paracentesis in an emergency situation requiring immediate 4
157157 reduction of the pressure inside the eye; 5
158158 (8) surgery requiring incision of the iris and ciliary body, including iris 6
159159 diathermy or cryotherapy; 7
160160 (9) surgery requiring the incision or removal of the vitreous; 8
161161 (10) surgery requiring incision of the retina; 9
162162 (11) surgical extraction of the crystalline lens; 10
163163 (12) surgical intraocular lens implants; 11
164164 (13) incisional or excisional surgery of the extraocular muscles; 12
165165 (14) surgery of the eyelid for suspected malignancies, for cosmetic 13
166166 purposes, or for cosmetic or mechanical repair of blepharochalasis, ptosis, and 14
167167 tarsorrhaphy; 15
168168 (15) surgery for the removal of lesions involving the eyelid margin, 16
169169 lacrimal supply, or drainage systems; 17
170170 (16) repair of an eyelid laceration larger than 2.5 centimeters, deeper 18
171171 than the orbicularis muscle, or involving the eyelid margin or lacrimal drainage 19
172172 structures; 20
173173 (17) surgery of the bony orbit, including orbital implants; 21 BILL AS INTRODUCED S.64
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178178 (18) incisional or excisional surgery of the lacrimal system other than 1
179179 probing or related procedures; 2
180180 (19) surgery requiring full-thickness conjunctivoplasty with graft or 3
181181 flap; 4
182182 (20) pterygium surgery; 5
183183 (21) ionizing radiation; 6
184184 (22) intraocular injections penetrating the globe; and 7
185185 (23) retrobulbar or intraorbital injections. 8
186186 (b)(1) An optometrist shall not prescribe or administer a drug or other 9
187187 substance that is listed as a Schedule I or II controlled substance pursuant to 10
188188 the federal Controlled Substances Act, 21 U.S.C. § 801 et seq., as amended, 11
189189 except as set forth in subdivision (2) of this subsection. 12
190190 (2) Notwithstanding subdivision (1) of this subsection, an optometrist 13
191191 may prescribe or administer hydrocodone in combination with analgesics, 14
192192 provided that an optometrist shall not prescribe more than a 72-hour supply of 15
193193 hydrocodone and shall not provide any refills of the prescription. 16
194194 Sec. 4. 26 V.S.A. chapter 30, subchapter 5 is amended to read: 17
195195 Subchapter 5. Diagnostic Pharmaceutical Agents Advanced Therapeutic 18
196196 Procedures Specialty 19
197197 § 1723. ADVANCED THERAPEUTIC PROCEDURES SPECIALTY 20 BILL AS INTRODUCED S.64
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202202 An optometrist who is licensed pursuant to subchapter 3 of this chapter may 1
203203 apply for an advanced therapeutic procedures specialty that authorizes the 2
204204 optometrist to perform the advanced therapeutic procedures set forth in 3
205205 subdivision 1703(2)(A)(vi) of this chapter. 4
206206 § 1724. QUALIFICATIONS FOR ADVANCED THERAPEUTIC 5
207207 PROCEDURES SPECIALTY 6
208208 (a) Generally. An optometrist shall obtain an advanced therapeutic 7
209209 procedures specialty in order to perform the advanced therapeutic procedures 8
210210 set forth in subdivision 1703(2)(A)(vi) of this chapter. The Board may grant 9
211211 an advanced therapeutic procedures specialty to an applicant who: 10
212212 (1) is licensed as an optometrist pursuant to subchapter 3 of this chapter; 11
213213 (2) meets the applicable requirements for education and demonstrated 12
214214 competency set forth in subsections (b) and (c) of this section; and 13
215215 (3) has completed the examination requirements set forth in subsection 14
216216 (d) of this section. 15
217217 (b) Educational requirements. 16
218218 (1) In order to obtain an advanced therapeutic procedures specialty, an 17
219219 optometrist who graduated from an optometric school or college prior to 2019 18
220220 shall have completed a postgraduate course sponsored by an organization 19
221221 approved by the Board of Optometry that had a minimum duration of 32 hours 20
222222 and included the following didactic classroom instruction: 21 BILL AS INTRODUCED S.64
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227227 (A) laser physics, hazards, and safety; 1
228228 (B) biophysics of lasers; 2
229229 (C) laser application in clinical optometry; 3
230230 (D) laser-tissue interactions; 4
231231 (E) laser indications, contraindications, and potential complications; 5
232232 (F) gonioscopy; 6
233233 (G) laser therapy for open-angle glaucoma; 7
234234 (H) laser therapy for angle closure glaucoma; 8
235235 (I) posterior capsulotomy; 9
236236 (J) common complications involving lids, lashes, and the lacrimal 10
237237 system; 11
238238 (K) medicolegal aspects of anterior segment procedures; 12
239239 (L) peripheral iridotomy; 13
240240 (M) laser trabeculoplasty; 14
241241 (N) minor surgical procedures; 15
242242 (O) overview of surgical instruments, asepsis, and occupational 16
243243 safety and health considerations; 17
244244 (P) surgical anatomy of the eyelids; 18
245245 (Q) emergency surgical procedures; 19
246246 (R) chalazion management; 20
247247 (S) techniques for and complications with local anesthesia; 21 BILL AS INTRODUCED S.64
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252252 (T) anaphylaxis and other emergencies that may occur in an office 1
253253 setting; 2
254254 (U) radiofrequency surgery; 3
255255 (V) postoperative wound care; and 4
256256 (W) clinical or laboratory experience that includes both video 5
257257 demonstration and in vitro observation or participation. 6
258258 (2) An optometrist who graduated from an optometric school or college 7
259259 in 2019 or later shall not be required to complete additional postgraduate 8
260260 coursework in order to obtain an advanced therapeutic procedures specialty. 9
261261 (c) Preceptorship requirements; competency demonstration. 10
262262 (1) In order to demonstrate competency for an advanced therapeutic 11
263263 procedures specialty, an optometrist shall complete a preceptorship during 12
264264 which the optometrist gains at least eight hours of clinical training that is 13
265265 supervised by a preceptor and demonstrates clinical proficiency with hands-on 14
266266 experience performing the following procedures on live, human patients: 15
267267 (A) at least two laser trabeculoplasties; 16
268268 (B) at least two posterior capsulotomies; 17
269269 (C) at least two laser peripheral iridotomies; 18
270270 (D) at least two chalazion excisions; 19
271271 (E) at least two chalazion intralesional injections; and 20 BILL AS INTRODUCED S.64
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276276 (F) at least two excisions or drainages of an authorized lesion of two 1
277277 millimeters or greater in size. 2
278278 (2) The preceptor shall be either: 3
279279 (A) an optometrist with a substantially similar scope of practice who 4
280280 has been licensed in Vermont or any other U.S. jurisdiction to provide the 5
281281 advanced procedures set forth in subdivision 1703(2)(A)(vi) of this chapter for 6
282282 at least three years; or 7
283283 (B) an ophthalmologist. 8
284284 (3) The preceptorship shall involve direct and in-person supervision of 9
285285 the optometrist by the preceptor. 10
286286 (4) The preceptorship shall take place in a state in which the preceptor is 11
287287 licensed and authorized to perform the advanced procedures. 12
288288 (5) The preceptor shall certify that the optometrist has competently 13
289289 completed the required procedures and provide a log of the completed 14
290290 procedures to the Board. 15
291291 (d) Examination requirements. The applicant shall successfully pass 16
292292 written and clinical examinations administered by the National Board of 17
293293 Examiners in Optometry (NBEO), including the NBEO Injections Skill 18
294294 Examination (ISE), the NBEO Laser and Surgical Procedures Examination 19
295295 (LSPE), and any other examination required by the Board by rule. 20
296296 (e) Advanced therapeutic procedures specialty by endorsement. 21 BILL AS INTRODUCED S.64
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301301 (1) The Board may issue an advanced therapeutic procedures specialty 1
302302 to an applicant who is licensed and in good standing in another U.S. 2
303303 jurisdiction and who: 3
304304 (A) has an expanded scope of practice that is substantially equivalent 4
305305 to or broader than the expanded scope of practice permitted by this subchapter; 5
306306 and 6
307307 (B) has been in good standing in the expanded scope of practice in 7
308308 the other jurisdiction for at least three years. 8
309309 (2) An optometrist whose advanced therapeutic procedures specialty 9
310310 was issued by endorsement pursuant to this subsection may serve as a 10
311311 preceptor in this State. 11
312312 § 1725. REPORTING REQUIREMENTS 12
313313 An optometrist shall report any adverse event related to an advanced 13
314314 procedure within 30 days following the event. 14
315315 Sec. 5. 26 V.S.A. § 1727 is redesignated to read: 15
316316 § 1727 1705. EXPIRATION DATE 16
317317 Sec. 6. EFFECTIVE DATE 17
318318 This act shall take effect on January 1, 2027. 18